Patrick Horgan

I am a Consultant in Substance Misuse based in Cumbria. I work for Unity Drug and Alcohol Recovery Services which is part of Greater Manchester Mental Health NHS Foundation Trust. I am particularly interested in developing processes to reduce drug related deaths and to improve care of patients who have problems with alcohol use.

Audit of opioid substitution treatment during Covid-19

– Aims
Prescribing patterns of opioid substitution treatment (OST) were compared before and after Covid-19 restrictions.

– Design
Prescribing information was obtained for two dates: Time 1 (17/03/20), which was before Covid-19 restrictions and Time 2 (15/06/20), which was after Covid-19 restrictions.

– Setting
The information was obtained from NHS community substance misuse services in England.

– Participants
Information relating to 2371 patients was analysed.

– Measurements
Data were collected about medication type and dose, frequency of dispensing and supervision status of patients on OST.

– Findings and conclusions
From 2371 patients, 18 had the type of medication changed (10 from methadone to buprenorphine). The remainder (Continuous Unchanged in Medication (CUIM)) were prescribed methadone (1826 patients) or buprenorphine (527 patients) at both times. The mean doses for methadone and buprenorphine at Time 1 for the CUIM group were 51.93 mg and 9.95 mg respectively. Similar percentages of patients had their methadone (14.57%) or buprenorphine (14.04%) changed. Of these, similar percentages of patients had their methadone (34.96%) or buprenorphine (37.84%) increased. In the CUIM group, 80.87% changed from 6 times per week pick up at Time 1 to once a week pick up in Time 2. At Time 1, 45.22% of patients were on supervised consumption whereas at Time 2, 1.27% of patients were on supervised consumption. Covid-19 restrictions resulted in marked changes to supervised consumption and pick up frequency. Switching to buprenorphine as a prescribing safety response did not occur. Future practice changes relating to supervised consumption and frequency of pickup may need consideration.

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